Carousel product for use in integrated restocking and dispensing system

ABSTRACT

A carousel used in a restocking system is comprised of a drive track. A plurality of bins are arranged into rows, with the rows being driven by said drive track. A drive mechanism, e.g. an electric motor, drives the drive track. A sensor is provided to sense the position of the rows of bins. A processor is responsive to the sensor and data representative of a plurality of picks for more than one order for controlling the drive mechanism. By combining picks from different orders into a batch, the time spent driving the rows and time between picks is minimized. The carousel may be divided into a plurality of columns, each with its own drive track, drive mechanism, and sensor, to enable several rows to be brought into a pick position simultaneously. Various methods and forms of restocking packages are also disclosed.

BACKGROUND OF THE INVENTION

[0001] 1. Field of the Invention

[0002] The present invention is directed to a carousel product which canbe used in a variety of ways to dispense and improve a restockingprocess, and can be used for a wide variety of associated tasks, e.g.inventory control, crediting returns, cycle counts, and the like.

[0003] 2. Description of the Background

[0004] Medical facilities, such as hospitals, nursing homes, etc. have acentralized location such as a pharmacy department or materialsmanagement department within the facility to coordinate the dispensingof drugs or medical supplies to the patients of the medical facility.The departments utilizing medications and medical supplies in suchfacilities have long been burdened with the increasingly complex recordkeeping and inventory management that results from caring for hundreds,if not thousands, of patients every day. Various methods have beenemployed to assist a centralized pharmacy or other centralized medicalsupply departments with maintaining accurate records while attempting toreduce the burden of managing all of the information associated with thedistribution of medications and medical supplies. The responsibilitiesof the centralized supply include: filling individual patientprescriptions on a daily basis; administration of drugs using the fiverights: right drug, right patient, right dose, right time and rightroute, dispensing medical supplies to patients; maintaining sufficientinventory of each drug or medical supply so as to have sufficientquantities on hand to administer to patients on a daily basis; trackingof drug interactions to prevent a patient from being given a drug thathas adverse affects when combined with other drugs; accounting for thepurchase of medications and medical supplies for use in the facility;accounting associated with dispensing of medications and medicalsupplies to individual patients; tracking of medication expiration datesto rid inventories of expired medications; and tracking of drug lotnumbers, for example, in the event of a recall of a particular drug ordrug lot number.

[0005] Medical facilities will dispense medications in one of threemodes: centralized, decentralized, or a hybrid of partialdecentralization. In facilities that are partly or fully decentralized,a very important function of the centralized pharmacy or materialsmanagement department is to restock various inventory locations, e.g.nurses stations, unit-based cabinets, satellite pharmacies, or off-sitefacilities in a network, with the quantity and types of medications andmedical supplies that must be dispensed by the decentralized locationson a daily basis.

[0006] The need for storage locations in medical facilities remote fromthe centralized storage location stems from the need to be able toquickly and conveniently dispense medications and medical supplies(whether controlled or uncontrolled) to patients. To be able todispense, there must be adequate supplies of the medications and medicalsupplies in the remote storage locations. To maintain the proper levelof medications and medical supplies, accurate inventory control isnecessary. Barring access to controlled substances by unauthorizedpersonnel is also a necessary feature. The contents of these storagelocations varies depending upon the medical procedures practiced in thearea where the storage location is situated. For example, a storagelocation near an emergency room will be stocked differently than astorage location next to a surgical suite. Nevertheless, it is importantto provide adequate supplies of all the required medications and medicalsupplies. It is also necessary to ensure that sufficient supplies aremaintained at the decentralized and centralized storage locationswithout overstocking, because overstocking increases the cost ofinventory by requiring more items to be maintained in inventory than areactually needed. Overstocking of inventory can also result in wastethrough spoilage of unused supplies. Excessive restocking of locationsis also demanding on the facility's staff who must devote more of theirtime to monitor the storage locations to ensure that sufficient suppliesare available.

[0007] A variety of systems have been developed to restock storagelocations or to fill patient medication/supply orders. In one suchsystem, referred to as a “cart exchange” system, dispensing cartsdistributed at dispensing locations in a medical facility areperiodically exchanged with filly supplied carts. These carts containmedications which satisfy the patients' current medications orders. The“used” cart is returned to the central supply area where inventorydecreases of particular medications or medical supplies are recorded andthe cart is restocked to predetermined “par” levels. These par levelsare intended to ensure constant availability of required medications ormedical supplies.

[0008] In a similar system, individual carts are used but are notremoved from their dispensing locations in the medical facility.Instead, a larger cart holding a variety of medications and medicalsupplies is circulated throughout the facility to restock individualcarts to their par levels.

[0009] Although these systems are generally effective in restockinglocations, they suffer from a number of drawbacks. One particulardrawback is the potential for stock-outs that can arise if theinventories of the carts are not closely monitored. Adequate inventorymonitoring can be problematic due to time limitations on the staff.Depletion of certain items from the carts can pose serious risks to thepatients in the medical facility. Another drawback is that restockingstorage locations is a very labor-intensive and inefficient process,especially when accurate inventory levels are not maintained in thecentralized or decentralized location. Sites with decentralizedlocations usually have many different locations, each of which isindividually restocked.

[0010] More recently, storage areas are being provided with dispensingcarts or cabinets having computer processors for recording removal ofmedications or medical supplies from the dispensing cabinets. Thesecarts or cabinets commonly include locked drawers having lockedmedication receptacles, and include computers. The computers commonlyprovide for limited access by selected medical personnel to such cartsand cabinets and limited access to specific drawers or locations thereinin response to entry of information into the computer. The computercreates inventory information for use by medical staff to ensure thecontinuity of the inventory in the carts or cabinets.

[0011] A system for restocking such computer controlled carts andcabinets is entitled Automated Restocking of Distributed MedicationDispensing Cabinets Using An Automated Medication Dispensing System,disclosed in U.S. application Ser. No. 09/480,819 and assigned to thesame assignee as the present invention. The disclosed systemautomatically fills restock packages based on inventory information orconfiguration changes provided by various carts and cabinets located atthe decentralized storage locations. The system encodes or otherwisedisposes on the restock package an information carrier containingidentifying information. To restock a dispensing cart or cabinet, astaff member decodes the information carrier encoded on the restockpackage. That may be accomplished by scanning a bar code or manuallyentering information into the cart's or cabinet's computer. Once thecart or cabinet confirms that the restock package is intended for it,the staff member loads the contents of the restock package into the cartor cabinet.

[0012] While the system of U.S. application Ser. No. 09/480,819 offerssubstantial advantages over other systems, some facilities may not havethe resources to convert to such an automated system. Further, thefacility may have the need to restock items which cannot be easilyplaced into a restocking package by automated equipment because of theirsize, weight, or configuration. Still other items may come from theirmanufacturers in bulk quantities or other types of packaging that makeit difficult to automatically load them into a restocking package. Thus,the need exists for a restocking system that is at least in part manual,while taking advantage of the data generated by computer controlledcarts and computer controlled cabinets. The need also exits for arestocking system that is at least in part manual, but can work side byside with computer automated restocking systems.

SUMMARY OF THE PRESENT INVENTION

[0013] The present invention is directed to a carousel (a type ofautomation device) used for distributing medications and medicalsupplies to patients (including, but not limited to, cart fill, firstdose, “Stat” doses, and “Now” doses), distributing medications andmedical supplies from centralized inventory locations to decentralizedinventory locations, restocking of decentralized medication locations(including but not limited to unit-based cabinets, satellite pharmacies,and remote facilities in a network), out of stock processing formedication or supply cabinets, nurse refill requests, and otherassociated tasks. Additionally, the carousel system may be used for theordering and receipt of medications and medical supplies fromdistributors and the tracking of inventory related to those activities.

[0014] The carousel is comprised of a drive track. A plurality of binsare arranged into rows, with the rows being driven by said drive track.A drive mechanism, e.g. an electric motor, drives the drive track. Asensor is provided to sense the position of the rows of bins. Aprocessor is responsive to the sensor and data representative of aplurality of “picks” (i.e. removal of items) for more than one order forcontrolling the drive mechanism. By combining picks from differentorders into a batch, the time spent driving the rows and time betweenpicks is minimized. The carousel may be divided into a plurality ofcolumns, each with its own drive track, drive mechanism, and sensor, toenable several rows to be brought into a pick position simultaneously.

[0015] The present invention is also directed to a variety of methods.In one method, a bar code on an open shelving unit is scanned with ahand-held device (wireless or connected). The quantity of itemsrequested is input through the hand held device for the scanned barcode. The bar code and quantity information are down loaded from thehand-held device and the information is queued in a restocking devicesuch as the previously described carousel.

[0016] In another method, an order to be filled is displayed at aworkstation. The order is initiated with a hand-held device (wireless orconnected). The order is manually filled. The final step is to indicatethrough the hand-held device that the order is filled so that anotherorder, if any, can be initiated without traveling to the workstation.

[0017] In another method, a restocking package is created from itemsheld in a carousel in a centralized storage location. The restockingpackage is delivered to a location so that the location may be restockedwith items from the restocking package.

[0018] In another method, a restocking package is filled with items in acentralized storage location. The restocking package is delivered toanother location. The restocking package is either inserted into aspecified location in a dispensing device or connected to the dispensingdevice.

[0019] The apparatus and methods of the present invention provide anumber of advantages in dispensing items from decentralized storagelocations and restocking the decentralized storage locations from acentralized storage location. Those, and other advantages and benefitswill become apparent from the Description of the Preferred Embodimentsherein below.

BRIEF DESCRIPTION OF THE DRAWINGS

[0020] For the present invention to be easily understood and readilypracticed, the present invention will now be described, for purposes ofillustration and not limitation, in conjunction with the followingfigures, wherein:

[0021]FIG. 1 is a diagram illustrating the relationship between acentralized storage location and, among other things, a plurality ofstorage locations;

[0022]FIG. 2 is a diagram illustrating a process for distributing itemsand restocking of items based, at least in part, on records createdduring distribution;

[0023]FIG. 3 is one example of hardware located at a decentralizedlocation implementing a closed system for performing dispensingoperations;

[0024]FIG. 4 is one example of hardware located at a decentralizedlocation implementing an open system for performing dispensingoperations;

[0025]FIG. 5 is one example of hardware located at the central locationfor enabling the manual assembly of restocking packages based on datagenerated by the hardware of FIG. 3 or FIG. 4;

[0026]FIGS. 5A and 5B illustrate embodiments of an order assembly table;

[0027]FIG. 6 illustrates two carousels and a workstation forimplementing advanced queue processing;

[0028]FIG. 7 is a diagram illustrating the order grouping feature of thepresent invention;

[0029]FIG. 8 is a flow chart illustrating the steps carried out by aprocessor controlling the carousel to process restocking orders in abatch mode;

[0030]FIG. 9 is another example of hardware located at the centrallocation for enabling the manual assembly of restocking packages basedon data generated by the hardware of FIG. 3 or FIG. 4;

[0031]FIG. 10 is a diagram illustrating the flow of information betweenthe computers used at various locations within a dispensing/restockingsystem; and

[0032]FIG. 11 illustrates a tote which may be used as a restockingpackage.

[0033] The specification includes an appendix which includes eight pagesof flow charts illustrating the process flow for various functions ofthe carousel of the present invention, a one page chart illustrating apatient fill process performed by an automation device such as a robot,and a one page chart illustrating a cabinet fill process performed by anautomation device such as a robot. The processes are implemented in thepresently preferred embodiment by software, stored in any appropriatememory device, which is executed by a computer.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0034]FIG. 1 is a diagram illustrating the relationship between acentralized storage location 10 and various inventory destinations,including a plurality of decentralized storage locations 12-1, 12-2through 12-n, patients 13, and a remote facility 14. Each of thedecentralized storage locations 12-1 through 12-n is capable ofdispensing items stored at the location. The items may includemedications, controlled medical supplies, medical supplies or items of anature consistent with the facility in which the system illustrated inFIG. 1 is located. Items may be dispensed directly from centralizedstorage location 10 to patients 13, or from the centralized storagelocation 10 to a remote facility 14. Data typically flows from thedecentralized storage locations 12-1 through 12-n to the centralizedstorage location 10. In response to that data, items are typically movedfrom the central storage location 10 to the decentralized storagelocations 12-1 through 12-n or to the remote facility 14 to restock suchlocations to either replenish dispensed items or to stock new items.Decentralized locations could include satellite pharmacies, computerizedmedication cabinets, stationary/mobile medication carts, nurse servers,remote hospital pharmacies, supply closets, supply cabinets, etc.Supplies can be reordered from distributors based on levels of stock inthe centralized storage location 10.

[0035]FIG. 2 illustrates a process which may begin with a step ofdispensing an item at step of 16 from one of the decentralized storagelocations 12-1 to a patient. A dispensing operation may occur in avariety of ways. In a medical facility, dispenses may be completed frommedication orders or they may be completed from inventory lists, to namea few types of dispensing operations. Assuming a medication has beendispensed from decentralized storage location 12-1, the medication mayeither be administered to a patient or returned as shown by step 18.Medications may be returned for a variety of reasons such as the patienthas checked out, been moved, or the patient's medication may have beenchanged. Medications may be returned to the decentralized storagelocation 12-1. Certain types of medications may simply be replaced inthe decentralized storage location 12-1 so as to be used in anotherdispensing operation, or may need to be disposed of.

[0036] The administration of medications occurring at step 18 may becarried out through the use of a hand-held device such as an AcuScan-Rx™device available from McKesson Automation, Inc., 700 Waterfront Drive,Pittsburgh, Pa. Such devices are wireless devices which communicate witha database to verify the administration of medications to patients. Suchcommunications enable the maintenance of a database of inventory levelsas shown by step 20. The database and associated computer system formaintaining the database of inventory levels may be located at thecentralized storage location 10 or may be located remote therefrom. Ineither event, the computer system necessary for maintaining the databaseprovides information which enables the centralized storage location 10to perform step 22 of generating a restocking package. As will bedescribed in greater detail below, the generation of the restockingpackage may be done completely automatically, manually, or through somecombination of manual and automatic processes. The restocking package isused to restock the decentralized storage location 12-1.

[0037] Restocking packages may also be generated at centralized location10 and delivered to the remote facility 14. From facility 14 an item maybe transferred as shown by step 24. The transfer may be a dispensingstep for a patient or a transfer to another location. Items may also bedispensed directly to the patient from the centralized location 10.

[0038]FIG. 3 illustrates one example of hardware which may be located atany of the decentralized locations 12-1 through 12-n. The hardwareillustrated in FIG. 3 is comprised of an AcuDose-Rx™ cabinet 26, havinga control computer 32, and an AcuDose-Rx™ auxiliary cabinet 28,available from McKesson Automation, Inc. A supply tower 30 is alsoillustrated. The control computer 32 controls the operation of thecabinet 26, auxiliary cabinet 28, and supply tower 30. The controlcomputer 32 is also in communication with the central database.

[0039] To perform a dispensing operation a user logs onto the controlcomputer 32. Based on the user's information, various drawers 31 in thecabinet 26 and the auxiliary cabinet 28, and various doors 33 on thesupply tower 30 are unlocked. Thereafter, patient information andinformation regarding items to be dispensed is entered. The items to bedispensed may include medications or medical supplies. After the item tobe dispensed has been removed, its removal is recorded at the controlcomputer 32. The user may continue to dispense items for the identifiedpatient, or patient information for another patient may be entered.Entry of information, including log-in, can be performed in a variety ofways, e.g., through entry with a keypad, barcode scanning, selectingitems from a pick list, RF ID, flash memory, magnetic strips, OCR, etc.Note that computerized medication cabinets like the AcuDose-Rx cabinetcan also track medications or supplies that are not stored in thecabinets 26, 28 or tower 30. For example, the control computer 32 cantrack virtual inventories, i.e., medications stored outside the cabinets26, 28 or tower 30. Examples include medications stored in arefrigerator whose inventory and transactions are recorded by thecontrol computer 32. The reader will understand that the hardwareillustrated in FIG. 3 is exemplary and is illustrated for purposes ofdemonstrating one type of hardware which may be located at thedecentralized storage locations 12-1 through 12-n.

[0040] The hardware illustrated in FIG. 3 limits access to the items tobe dispensed to those individuals who have properly logged on. Thus, thehardware illustrated in FIG. 3 is referred to as a closed system forperforming dispensing operations because a dispensing operation cannotbe performed unless the user is identified to, and recognized by, thecontrol computer 32.

[0041]FIG. 4 illustrates another example of hardware which may belocated at any of the decentralized storage locations 12-1 through 12-n.The hardware is comprised of a first shelving unit 34 and a secondshelving unit 36. An optional interface computer 38 may be provided,which is in communication with the database. If the interface computeris 38 is not provided, a handheld device 40 can be carried into the areato perform the inventory of the shelves. The handheld device 40 is takenback to the centralized storage location 10 where the information isdownloaded in any appropriate manner. Alternatively, the hand-helddevice 40 could be a wireless device communicating over a wirelessnetwork link. Alternatively, and as shown in FIG. 4, the hand-helddevice 40 may be located in the area and have a docking cradle 41 incommunication with the interface computer 38.

[0042] Each of the shelving units 34, 36 is comprised of a plurality ofbins 42. Each of the bins carries indicia 44 which may be, for example,a barcode and/or a label identifying the contents of the bin.Additionally, items in the bins may have a bar code, label or otherindicia directly on them or on their packaging. The bar code could bescanned, or other methods of inputting the data consistent with the typeof indicia used, or push buttons or the like actuated, to perform adispensing or other type of operation. In addition, the handheld device40 could be used to generate an ad hoc order through its screen entry inthe event that an item is not available to be scanned or otherwise havedata pertinent thereto input. The number of shelving units 34, 36 andthe configuration of the bins 42, depends upon the number and size ofthe items to be stocked. Because access to the bins 42 is notrestricted, the hardware illustrated in FIG. 4 is referred to as an opensystem for performing dispensing operations. The reader will understandthat the hardware illustrated in FIG. 4 is exemplary and is illustratedfor purposes of demonstrating one type of hardware which may be locatedat the decentralized storage locations 12-1 through 12-n.

[0043] The hand-held device 40 may be a wireless scanning device such asa Symbol 7240 or Welch Allyn 7400. In one mode of operation, theoperator may use the hand-held device 40 to scan the barcode indicia 44for each bin for which a restock is desired. The operator will theninput the order quantity on the hand-held device 40. When the hand-helddevice 40 is docked in its cradle 41, the data will be downloaded. Thedata will then be queued to be processed to generate a restockingpackage. Use of the hand-held device 40 eliminates the manual task ofordering items to be restocked, and reduces the potential for errors.

[0044]FIG. 5 illustrates one example of hardware located at the centrallocation 10 for enabling the manual assembly of a restocking packagebased on data generated by the hardware illustrated in FIGS. 3 and 4.FIG. 5 illustrates a carousel 46 comprised of a plurality of bins 48arranged in a plurality of rows 50. The rows 50 of bins 48 are connectedto a drive track 52, which may be, for example, a pair of endless beltsor chains. The rows 50 of bins 48 are connected to the drive track 52through a swivel connection 54 which enables the rows 50 of bins 48 tomaintain a horizontal position as the rows 50 are driven by the drivetrack 52. Each of the bins 48 carries indicia 55, which may be, forexample, a barcode and/or a label indicating the contents of the bin,similar to indicia 44 in FIG. 4.

[0045] The drive track 52 is driven by, for example, an electric motor56. The electric motor 56 may drive the drive track through one or moredrive gears 58 in the case of a chain type of drive track or through apulley in the case of a belt type of drive track. In addition to use ofan electric motor 56, hydraulics or any other appropriate mechanism fordriving the drive track 52 may be used. A sensor 60 may be provided tosense the position of the rows 50 of bins 48. Alternatively, a shaftencoder may be provided for motor 56 for keeping track of the degree ofrotation of the motor's 56 shaft and, through knowledge of the gearingand the previous position of the rows 50, the position of the rows canbe controlled. Use of the word “sensing” is intended to cover any of thevarious known method of sensing and/or calculating the position of therows 50.

[0046] The carousel 46 is under the control of a workstation 62, whichmay be comprised of a personal computer in communication with thedatabase. The workstation 62 receives information from the databaseregarding items, and quantities for each item, needed to replenish eachof the decentralized storage locations 12-1 through 12-n or to fulfillpatient dispenses. The workstation 62 processes the information andpresents to the user through a screen 64 a series of operations referredto as “picks”. The information displayed on the screen may include, forexample, an identification of the decentralized storage location, anidentification of a cabinet, tower, shelving unit, etc. at thedecentralized location, an identification of the patient, the item andquantity to be picked. The workstation 62 also controls a printer 71which can print barcode labels 72.

[0047] A label 72 with a barcode indicating the item (medication,supply, or kit) and the destination (cabinet, patient, etc.) will beprinted from the printer 71. the user will scan that barcode with ascanner to activate the carousel picking process. The carouseldynamically evaluates the work queue of requests (patient dispenses,cabinet refills, on demand picks, stat, now, etc.) based on a configuredset of priorities, set by the user. These priorities allow a medicalfacility to configure the order in which the different requests will beprocessed. Additionally, the facility may set up different priorityordering for different time periods in the day. For example, first dosesmay be disabled or prioritized lower during the hours of a cart fill.This work queue can also be paused at any time to perform an on-demandpick or restock. That allows user to pick an urgent item that may be inthe queue.

[0048] To enable a pick to be performed, the workstation 62 activatesmotor 56 to bring the row 50 having the desired item into a pickposition. In FIG. 5, the row 50′ is illustrated in the pick position.When in the pick position, a plurality of indicia 66 are adjacent toeach of the bins 48 in the row 50′ in the pick position The indicia mayinclude, for example, LEDs or an alphanumeric display. The locationcould also be indicated on an LCD Display or workstation 62. Theworkstation 62 may cause a number of LEDs equal to the quantity of itemsto be picked and adjacent to the bin 48 having the items to be picked toilluminate. Alternatively, an alphanumeric screen could be lit with thequantity of items to be picked from the adjacent bin 48. That issometimes referred to as “pick-to-light” technology.

[0049] To finish the pick, a hand-held wireless device 68 is used toscan the bin label or item barcode 55. If the quantity that was pickedfrom the device was not the full requested amount (because of an out ofstock or expiration condition), the user can adjust the quantity pickedand record a reason for the discrepancy before completing the pick. Thebarcode 72 that is printed at the beginning of the process (whichinitiates the picking) and the barcode on the bin or item that isscanned to complete the process are different formats to require theuser to scan each of these barcodes (if the same information was encodedin each barcode, the user could scan one of the barcodes twice and wouldlose a critical validation to prevent picking of the incorrect item). Analternative method of indicating the completion of the pick could be topush a button or any other physical manifestation intended to representthe completion of the pick. The user then moves to the workstation 62and initiates the next pick.

[0050] According to the present invention, when a pick is displayed onthe workstation 62, the pick can be initiated either on the workstation62 or via the hand-held device 68. Once the pick is processed, thehand-held device 68 may be used or a barcode on the centralized storagelocation may be scanned to indicate that the pick is complete and toinitiate the next pick without having to travel to the workstation 62.In a large centralized storage location having numerous carousels 46under the control of a single workstation 62, the ability to complete apick and initiate the next pick using the hand-held device 68 eliminatestravel time to and from the workstation.

[0051] To increase picking efficiency, a “place-to-light” system,described below in conjunction with FIGS. 5A and 5B, can be used whichwill allow multiple pick requests to be processed at one time. Thesystem would print out multiple barcodes to begin processing of a batchof items. The user would located these barcodes in identified locations,indicated by lights. The system would take the most efficient (shortest)path through the bins to pick items for the batch of requests. Thatallows more efficient movements of the carousel and, if several pickrequests require the same item, the device can stop on that item's binonce and allow the picking for each item in the batch.

[0052] Another way to increase efficiency is to implement advance queueprocessing for a medical facility that has multiple carousels. In FIG.6, the carousel workstation 119 controls N number of carousels (twoshown as 120 and 121, but there could be any number of carousels). Thecarousel system picks the highest priority item from the queue andprints a barcode label 122. The user scans the barcode and theappropriate carousel (based on current processing and the inventorystocked in the carousel) will move to the correct location. For example,carousel 120 will move row 123 into the pick position. The carouselsystem will automatically evaluate the queue and the carousels' status.If there is an idle carousel and the next item on the queue is locatedin that carousel, a label 124 will be printed and the carousel 121 willbegin moving the rows to bring the correct row 125 into the pickposition. This allows the carousel 121 to bring row 125 into place whilethe user is picking an item from row 123 from carousel 120.

[0053] One of the features of the present invention is the carousel's 46ability to be controlled in a manner so that a plurality of picks formore than one order can be processed. Referring to FIG. 7, a portion ofthe drive track 52 is schematically illustrated. Assume that the line 70is representative of the pick position and each of the x's on the track52 is representative of a row of bins. Assume further that three ordersare being processed, one order each for patients (or decentralizedstorage locations) A, B and C and that three picks are needed for each.A-1 is representative of the first pick for A and it is seen that therow containing the first item to be picked for A is in the pick position70. Moving counterclockwise around track 52, we see that the first pickB-1 for B is next, the first pick C-1 for C is next, followed by thesecond pick B-2 for B, etc. According to the prior art, picks for apatient/location would normally be queued and presented serially. Thus,after the pick A-1 is completed, the track 52 would be driven so thatthe pick A-2 could be performed, followed by the pick A-3. After thepicks for A were completed, the row for pick A-3 would be in the pickposition. Accordingly, it would be necessary to drive the row containingthe pick B-1 into the pick position 70. Thereafter, the rows would bedriven so that picks B-2 and B-3 could be performed. The three picks forC would then be serially performed.

[0054] According to the present invention, the picks for A, B and C maybe integrated so as to minimize the time between picks. For example,referring to FIGS. 5A and 5B, two examples of an order assembly table 73are illustrated. Each order assembly table has a plurality of locations74, 75 and 76 which may be assigned to A, B, and C, respectively.Referring now to FIG. 6, the pick A-1 is completed and placed, throughthe use of light 74 a indicating the location to be placed, in position74. Thereafter, the pick B-1 is completed and placed in position 75 withthe aid of light 75 b, followed by the pick C-1, which is placed in 76with the aid of light 76 c. Then the pick B-2 is performed, which isplaced in position 75, followed by the pick A-2, which is placed inposition 74. The next two picks, C-2 and C-3, are placed in position 76,followed by pick A-3, which is placed in position 74, and pick B-3,which is placed in position 75, all with the aid of lights 74 a, 75 b,and 76 c. Thus, by integrating picks, either or a patient basis, cabinetbasis, shelving unit basis, or the like, the amount of travelexperienced by the rows 50 of bins 48 is minimized, as is the timebetween picks. Information about the picks can be provided on thehand-held device 68, computer screen 64, and/or via the indicia 66, sothat the user is provided with information regarding the item, quantity,and order to which the pick belongs.

[0055]FIG. 8 is flow chart illustrating the steps carried out by theworkstation 62 for controlling the carousel 46. Beginning at step 100, amode status is retrieved and queried at step 101. If the auto modestatus is off, process flow continues with a check for “demand picks” atsteps 102 and 103. If there are no demand picks, process flow returns tostep 100. If there are demand picks, process flow proceeds to step 104where a message is sent to move the carousel to the next bin. If therequest is not complete as shown by step 105, another message is sent tomove the carousel to the next bin, which continues until the request iscomplete, at which time process flow returns to step 100.

[0056] If at step 101 the auto mode is on, fill priorities are retrievedat step 106, and the next fill request is retrieved at step 107. Adecision step 108 verifies that there are items to access. If there areno items to access, process flow returns to step 100.

[0057] If there are items to access, step 109 identifies if any are notin the carousel. Step 110 is a decision step that determines if thereare any non-carousel items on the list and, if not, process flowproceeds with step 111 to identify the carousel printer 71. If there arenon-carousel items on the list, the non-carousel item printer isidentified at step 112, a barcode label is printed at step 113, and adecision step 114 determines if all items are non-carousel. If theanswer at decision step 114 is “yes”, process flow returns to step 100;if “no” process flow proceeds to step 111.

[0058] From step 111, process flow continues with step 115 in which abarcode label is printed. At step 116, the process pauses to wait for alabel scan message indicating that the user has scanned the printedbarcode label. At step 117 the most efficient path is determined.Process flow continues with step 104.

[0059] Carousels which may be modified to provide the functionality ofthe carousel 46 are available from a number of manufacturers such asWhite and Remstar. Exemplary hardware specifications are found inTable 1. TABLE No.1 Hardware Specifications Remstar Model 180S-18-15 orequivalent Carrier Capacity (lbs.) 485 Total Unit Capacity (lbs.) 13,448Number of Carriers 18 Number of Intermediate Shelves 18 Pitch (inches)15 Height (feet) 13′6″ Max Imbalance Load (lbs) 1,540 Depth of carrier(inches) 15.0 Max. Rotation Speed (inches/secs.) 5.9 Width of unit(inches) 115.6 Depth of Unit (inches) 46.5 Power Supply 208/220 V 3˜/60Hz Pick-to-Light Technology Remstar Controller T-88 15 Amp service 480Volts 1 posting board Beacon lights on shelf

[0060] As seen from Table 1, carousels may easily be 10 feet or more inwidth. Because the carousel must be designed based on the heaviest itemto be dispensed, the carousel may be considerably over-designed for manyof the items to be carried. According to another aspect of the presentinvention, a carousel 88 may have a “slot-machine” design as shown inFIG. 9. The carousel 88 of FIG. 9 has a plurality of tracks 52, eachhaving its own electric motor 56 and drive gears (not shown). Each ofthe drive tracks 52 has connected to it its own plurality of binsarranged in a plurality of rows 50. In that way, the carousel 88 may bedesigned in a number of discreet columns with one of the columnsdesigned for dispensing heavier items, and the other columns designedfor dispensing lighter items. The column dispensing the lighter itemsneed not be engineered to carry the same amount of weight as the columndesigned to carry the heavier items, and therefore can be made moreinexpensively. Additionally, because it is to dispense lighter items, asmaller motor may be used as well as different gearing. Anotheradvantage of the “slot-machine” concept is the need for varying speedsin the automation. The fast moving items will be stored in the fastmoving tracks and the heavier and bulkier items in a slower movingtrack. The multiple rotating columns could minimize wait items for theoperator by indexing to the next pick location in the columns where theoperator is not currently picking.

[0061] Although the present invention has been described in conjunctionwith a vertical carousel, the concepts of the present invention could beimplemented using a horizontal type of carousel.

[0062] Other types of hardware which may be used at the centralizedstorage location 10 include a system of the type disclosed in U.S. Pat.No. 5,593,267 entitled “Automated System for Selecting and DeliveringPackages from a Storage Area,” U.S. Pat. No. 5,880,443 entitled“Automated System for Selecting Packages from a Cylindrical StorageArea,” and U.S. patent application Ser. No. 09/480,819 entitled “AnAutomated Medication Dispensing System,” all of which are herebyincorporated by reference. It is anticipated that the centralizedlocation may be comprised of various types of hardware such as carouselsillustrated in FIG. 5 and FIG. 9, and/or the hardware identified in theaforementioned patents and pending application. The centralized storagelocation may be completely automated, partially automated by having botha carousel and, for example, a computer-controlled robot, or completelymanual by having one or more carousels. In that manner, a manualrestocking system based on a carousel can be used side-by-side with anautomated restocking system based on a robot.

[0063]FIG. 10 illustrates the computers used at various locations withina dispensing/restocking system of the type disclosed herein. As seen inFIG. 10, decentralized storage location 12-1 is where control computer32 (if supplied) is located. Decentralized storage location 12-n iswhere interface computer 38 (if supplied) is located. The carousel workstation 62 is located at the centralized storage location 10. Thecentralized storage location 10 may also have a Robot-Rx support station89 which is used to control a robot.

[0064] A computer 90, which may be located at centralized storagelocation 10 or may be located elsewhere, maintains the database for thesystem. The computer 90 receives information from the decentralizedstorage locations 12-1 through 12-n and provides information to thecarousel work station 62 and/or the Robot-Rx support station 89 toenable restocking packages 96 to be prepared. Additionally, dispenses topatients, distributions to satellite facilities, and the like may occurfrom centralized location 10. An interface PC 92 may be provided toenable external systems, such as a PC 94 on which a hospital informationsystem resides, to communicate with the computer 90 on which thedatabase is located. Completing the description of FIG. 10, as has beenpreviously described, restocking packages 96 are prepared at thecentralized storage location 10 and delivered to the decentralizedstorage locations 12-1 through 12-n.

[0065] The carousels 46, 88 of the present invention support cyclecounts to verify inventory. The carousel system is semi-manual, somaintaining accurate inventory is very important to the operation of thesystem. To ensure accurate inventory levels, the carousel systemsupports various cycle count options which allow a user with the correctsecurity privileges to periodically perform a physical count of theitems in a bin. This process allows users to count controlled substances(based on DEA code) or other identified items (for example, high-cost orhigh-usage items) on one schedule (for example, daily or weekly) andthen the remaining items on a different schedule (for example, monthly).In operation, the carousel will automatically move the shelves to thenext bin that needs to be counted, the user will count the inventory andinput the current inventory count into the workstation, and if adiscrepancy exists, it will be logged with the user information and areason. Once the count is completed, the carousel system will record thebin as counted with the current date and time and move to the next binto be counted. The next bin will then be moved to and counted. Therecently counted bins can be manually counted at any time, but will notshow up in the automatic cycle count process until the next scheduledtime. Such inventory counts help prevent out of stocks, help identifyexpirations, and provide better management of inventory

[0066] Where centralized storage location 10 is used to restockdecentralized locations 12-1 through 12-n having AcuDose-Rx™ cabinets,the restocking process may be initiated in an automated manner. Theability to track inventory levels on the AcuDose-Rx™ cabinets enablesthe database computer 90 to indicate when par levels are low and willtrigger a flag for the restock to occur, as opposed to restock happeningat periodic times or other methods not based on actual levels.Furthermore, the loop can be closed on the restocking process forAcuDose-Rx™ cabinets through the verification of the restocked orders atthe cabinet. For example the carousel 46, 88 will process the restockorders for the AcuDose-Rx™ cabinet, and after the order is filled anddelivered to the cabinet on the floor, the labels will be scanned at thecabinet to verify that the indicated amount on the restock report isactually loaded into the cabinet. This is especially useful fornarcotics and other expensive or controlled medications. If the expectedquantity to be restocked was not actually restocked at the cabinet, adiscrepancy can be created and reported on or a notification can bedisplayed to the central location.

[0067] A system of the type illustrated in FIG. 1 implemented with thehardware of FIGS. 3, 4 and 5, and 9 may be provided with the followingfunctionality.

[0068] Multiple and configurable fill times for batch fills. Eachnursing unit can be configured with custom fill times, which will causethe carousel work station 62 and/or Robot-Rx™ support station 89 to fillorders only within the configured time period. Additionally, eachnursing unit can be configured with more than one fill time to supportcentralized storage locations that do just-in-time or multiple fills perday.

[0069] Batch fills process off of delivery units, which are logicalgroupings of nursing units in the facility. This allows centralizedstorage locations to fill several nursing units at one time as part of acart exchange (for example, all nursing units on the second floor).

[0070] Real-time admission, discharge and transfer (ADT) and orderchange processing during filling and a corresponding pre-delivery check.Any patient admission, discharge, or transfer or order discontinuing orchanging a quantity will be processed during the fill processing. Thatprevents incorrect orders from being delivered and prevents patientmedications from being delivered to the wrong room.

[0071] Track the delivery times for patients or decentralized locationsthat are filled by the carousel. That is important when filling patientorders, because knowing whether something made a cart fill or not wouldgive the system the ability to know whether a first dose needs to besent up to the patient to fulfill an order or whether it can be servedby the cart exchange. Knowing when the delivery occurs lets you knowwhether an order change is caught by the pre-delivery check and is partof the delivery. It also gives the system the ability to get billingrecords correct for a patient.

[0072] Support for dose calculations to fill requests when a specificdose is not present. For example, one Tylenol 500 MG table may beordered, but may be filled by picking two 250 MG tablets.

[0073] Support for medication kits. Orders for medication kits are formultiple items stored in the carousel. For example, a kit might consistof medication A, medication B, and the IV tubing necessary to deliverthe medication. The system can associate one medication order to allthree of these line items and dispense them and bill for them all as oneitem.

[0074] Different checking options exist to support different stateregulations. Supported options include checking all orders, checking noorders, checking manually picked orders, and random checking ofpatients.

[0075] The carousel will implement two methods of restocking items thatare low on inventory. One will be a static method, where the hospitalconfigures a maximum and par level for each item in the carousel. Oncethe inventory falls below the par level, the item will be requested as arestock. The second method is to configure a maximum level, but todynamically calculate the hospital's daily usage of an item based onhistorical data. This allows a moving average as item usage changes(changes in formulary or purchasing patterns, seasonal variations,etc.).

[0076] The events and transactions generated from the carousel and otherautomated systems will be moved to a separate long-term storage system.This system will record the dispense, inventory count, restock, andconfiguration (assignment and de-assignment) actions taken against thecarousel, including, but not limited to, the following information: dateand time, station, user, medication, and quantity. This data archivingsystem will allow users to periodically record these transactions to arecordable CD (CD-R). Because the carousel can store controlledsubstances, the recording of activity against these medications isrequired by law. Additionally, this storage system can provide long-termdata analysis such as medication usage, processing efficiencies, anduser actions.

[0077] Dispensing logic between pharmacy automation devices andunit-based cabinets. This logic helps prevent medications that could bedispensed from more than one system (pharmacy automation systems such asthe ROBOT-Rx device or carousel, and unit based cabinets such asAcuDose-Rx cabinet) from being dispensed to a patient from multiplesystems. A potential medication error is to, for example, allow a userto dispense a medication from a cabinet, and then have the samemedication for the same order be delivered to the patient room from acart fill or first dose fill from the pharmacy. The systems willevaluate whether the medication can be filled by a unit-based cabinetand/or a pharmacy automation product and decide, based onconfigurations, to which device to send the medication fill request.This functionality allows configuration on a unit or medication level,and allows configuration based on order types (PRN, scheduled, etc.) andDEA codes (controlled substances).

[0078] Configurable fill priorities which automatically sends certainorders to a configured automation device based on priorities and statusof the restocking devices. Fill priorities can include, but are notlimited to, filling new medication orders, stat medication orders,decentralized inventories, etc.

[0079] Track the lot numbers for all medications or supplies stockedinto the carousel. As a result, if a recall occurs, the system can knowwhether that lot number was ever in the carousel and to whom themedications or supply was dispensed.

[0080] Allow operators to process credits and returns ofmedications/supplies. Medications and supplies are often not usedbecause a patient is discharged, orders are cancelled, or other reasons.As a result, it is important for the system to process these returns bycrediting the patient's account for the returned medication/supply,returning it to stock, and then updating the carousel inventory.

[0081] The carousel will provide optimization processes which willidentify, based on historical drug usage information, the optimal binplacement for the item. For example, the highest use items will belocated on the same shelves to minimize travel distance between picks.Additionally, queue and pick processing will evaluate the optimal pathto traverse. Inventory logic tracks the utilization rates of allmedication in the carousel and generates reports which indicate whichitems might not be used frequently enough to take up space in thecarousel as well as those items which receive a sufficient volume oforders to warrant being added to the carousel. These reports indicatehigh volume, non-automated items and low volume, automated items.

[0082] Items that could not be picked from the centralized storagedevice (because of an out of stock condition or because the item is notstored in the device) will be directed to a manual pick process. Themanual pick process allows a pick report (exception list) to bedisplayed and printed, which displays an list of medications or suppliesand the total quantity needed for the manual pick batch and displays areport for each patient identifying each item and the quantity required.The manual pick list displays patient information, including name, ID,location, and facility, along with order information such as the orderdescription, route, frequency, dosage, and special instructions. Sitesmay configure to display the configured system drug name or the drugdescription passed with the order from the Pharmacy Information System.Additionally, the manual pick items may be directed to a label printerto generate a series of labels, one for each manual pick item.

[0083] Dispensing software which prints out a barcode (or other form ofidentification) to serve as a “license plate” for the dispensing packagefrom the carousel. This license plate can be used to close the loop onthe delivery of the package to its final destination, such as acomputerized medication cabinet. As a result, if there is a diversion ofmedications or supplies and they don't make it to their intendeddestination, a discrepancy can be denoted, particularly if the ultimatedelivery location is an AcuDose-Rx cabinet which is on the Connect-Rxplatform with the carousel.

[0084] The carousel may send pick requests to an automated, controlledsubstance vault. Some controlled substances may not be able to bestocked in the carousel. However, the carousel control software couldsend a request to open the door to a controlled substance vault, likethe narcotics vault, and lead the operator to pick a medication fromthis vault if it was required to compete a restock package or dispense.

[0085] The restocking packages 96 may take a variety of forms. Therestocking packages 96 may also be patient specific or room specific. Inone embodiment, the user delivers the patient or room specificrestocking package to the decentralized storage location 12-1 through12-n and is directed to load the medications into a patient/roomspecific area. In other embodiments, the restocking package is insertedinto or connected into the unit's hardware. Dispenses are then madeunder the control of the control computer 32. Advantages of thisapproach include:

[0086] Development of a “nursing focused” medication administrationdispensing system

[0087] Dispensing patient specific medications

[0088] Dispensing time specific medications

[0089] Nursing unit specific

[0090] Fixed or mobile

[0091] Bar code driven

[0092] In the various embodiments of the patient specific/room specificprocess medications are stocked in a robot system or a carousel system.A pharmacy information system (PIS) sends a fill list to the databasecomputer 90, which sends instructions to either the carousel workstation62 or the robot support station 89; medications are picked from thecarousel or picked automatically by the robot, respectively. From thatpoint on, the process is patient or room specific.

[0093] In a first embodiment of the patient specific/room specificprocess:

[0094] The picked medications are delivered into patient specificcontainers (envelope or bin) and may or may not be arranged in a timespecific order.

[0095] The container is loaded onto a mobile cart which is identifiedfor a particular decentralized storage location (statically ordynamically). The mobile cart includes an on-board chip that carries thecart's ID. Information about the medications currently stocked in thecart is also maintained by the on-board chip.

[0096] The cart is delivered to the decentralized location.

[0097] The cart is electronically connected to the control computer 32(FIG. 3). Once connected, the control computer recognizes the mobilecart's ID.

[0098] Items are dispensed from the cart under the control of controlcomputer 32. The mobile cart may include a visual indication to aid inthe placement or retrieval of items.

[0099] As items are dispensed from the mobile cart, informationmaintained by the on-board chip is modified accordingly.

[0100] Bar coded envelope and/or medications may be scanned at thedecentralized storage location for verification.

[0101] When replenishment becomes necessary, the mobile cart may bereturned to the central pharmacy and connected to the carousel orRobot-Rx robot at which time the information on the chip may be accessed

[0102] Once connected, the carousel or robot identifies the system andmay automatically perform a refill for the mobile cart.

[0103] In a second embodiment of the patient specific/room specificprocess:

[0104] Picked medications are delivered into patient specific containers(envelope) and may or may not be arranged in a time specific order.

[0105] The envelopes are loaded into a tote, see FIG. 11, which mayinclude an on-board chip.

[0106] The tote is delivered to a decentralized location (with a tower)and identified at the control computer 32.

[0107] The tote is inserted into the tower or cabinet.

[0108] Items are dispensed from the tower under the control of thecontrol computer 32.

[0109] Bar coded envelope and/or medications may be scanned at thedecentralized storage location for verification.

[0110] In a third embodiment of the patient specific/room specificprocess:

[0111] Picked items are delivered into a patient specific container, andmay or may not be arranged in a time specific order.

[0112] Specific locations within the cabinet or auxiliary cabinet aredesignated as “patient specific pockets” and are lock-lidded.

[0113] The user scans the container at the decentralized storagelocation.

[0114] The control computer 32 recognizes the patient specific items andidentifies the pocket into which the items are to be loaded.

[0115] Items are then dispensed from the cabinet or auxiliary cabinetunder the control of computer 32.

[0116] Bar coded envelope and/or medications may be scanned at thedecentralized storage location for verification.

[0117] While the present invention has been described in connection withexemplary embodiments thereof, those of ordinary skill in the art willrecognize that any modifications and variations are possible.Accordingly, the scope of the present invention is intended to belimited only by the following claims and to any equivalents thereof.

What is claimed is:
 1. A carousel, comprising: a drive track; aplurality of bins arranged into rows, said bins being driven by saiddrive track; a drive mechanism for driving said drive track; a sensorfor sensing the position of said rows of bins; and a processorresponsive to said sensor and data representative of a plurality ofpicks for more than one order for controlling said drive mechanism. 2.The carousel of claim 1 wherein said processor is responsive to datarepresentative of picks for more than one patient.
 3. The carousel ofclaim 1 wherein said processor is responsive to data representative ofpicks for more than one storage cabinet.
 4. The carousel of claim 1additionally comprising a display responsive to said processor, saiddisplay located adjacent each row as each row is brought into a pickposition.
 5. The carousel of claim 4 wherein each display identifies thequantity to be picked and the order to which the pick belongs.
 6. Acarousel comprising: first and second drive tracks; a plurality of binsarranged into first and second pluralities of rows, said first pluralityof rows being driven by said first drive track, said second plurality ofrows being driven by said second drive track; first and second drivemechanisms for driving said first and second drive tracks, respectively;sensors for sensing the position of said first and second pluralities ofrows of bins; and a processor responsive to said sensors and datarepresentative of a pick from said first plurality of rows and saidsecond plurality of rows for controlling said drive mechanism.
 7. Amethod comprising: scanning a bar code with a hand-held device;inputting a quantity through the hand held device for the scanned barcode; downloading the bar code and quantity information from thehand-held device; and queuing the information in a restocking device. 8.A method comprising: displaying an order to be filled at a workstation;initiating the order with a hand-held device; filling the ordermanually; indicating through the hand-held device that the order isfilled; and displaying another order to be filled at the work station.9. A method comprising: creating a restocking package from items held ina carousel in a centralized storage location; delivering the restockingpackage to a decentralized location; and restocking the decentralizedlocation with items from the restocking package.
 10. The method of claim9 wherein the restocking step includes removing items from therestocking package and inserting the items into specific locations. 11.The method of claim 9 wherein the restocking step includes inserting therestocking package into a specific location.
 12. The method of claim 9wherein the restocking step includes attaching the restocking package toa dispensing device.
 13. A method comprising: creating a restockingpackage with items in a centralized storage location; delivering therestocking package to a decentralized location; and one of inserting therestocking package into a specified location in a dispensing device orconnecting the restocking package to the dispensing device.